MORE CHOICE AND CONVENIENCE ENJOY INTEGRATED BENEFITS WITH CLASSIC BLUE COMPREHENSIVE COVERAGE

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YOUR COVERAGE OFFERS YOU MORE Freedom to see the provider of your choice. You can receive services from any provider you choose, because you are not limited to a select network. Total support regardless of your health status, including an exceptional range of health education offerings, online tools to help you make appropriate, informed care choices, and 24-hour access to confidential health information and care decision support. Blue Plan discounts to reduce your out-of-pocket care costs. Assurance that no matter where you travel, across the state and around the world, you have access to covered care. Your Classic Blue Comprehensive coverage may be issued or administered by Highmark Blue Cross Blue Shield or Highmark Health Insurance Company, a wholly-owned subsidiary of Highmark Inc.

ENJOY THE ADVANTAGES OF CLASSIC BLUE COMPREHENSIVE COVERAGE Classic Blue Comprehensive gives you freedom to choose any provider or hospital you want With Classic Blue Comprehensive, health care benefits are provided in one convenient, integrated program. These benefits include coverage for hospital services, physician services and services covered by many other eligible providers. Most benefits are subject to a deductible and coinsurance, which require you to share a portion of the medical costs. Health care providers can be hospitals, doctors, skilled nursing facilities or other health care facilities or professionals who provide health care services eligible for coverage under your Classic Blue Comprehensive program. You are not required to select a primary care provider, but it makes good sense to select a personal physician anyway. Having one physician provide or coordinate your preventive and sick care helps to ensure that your care is coordinated and consistent. Your personal physician can be your best guide to appropriate specialty care when you need it. If you decide to select a personal physician, you and each covered family member can choose a different doctor.

HOW YOUR CLASSIC BLUE COMPREHENSIVE PROGRAM WORKS With Blue Cross Blue Shield, there is an important distinction among providers – participating vs. non-participating. The choice is yours. Care you receive from participating providers You must use Highmark Blue Cross Blue Shield participating providers to receive paid-in-full benefits for the provider’s reasonable charge for covered or eligible services. Participating providers are health care professionals and facilities that have signed an agreement with Highmark and agree to accept the amount that Highmark has determined to be a reasonable charge for covered services as payment in full. Just show your identification card and the provider will file a claim for you and will receive reimbursement directly for services provided to you. You are responsible for paying any deductible and/or coinsurance amounts included in your program. Of course, any health care expenses not covered under your program are always your responsibility to pay directly to the provider.

To ensure that a provider is participating, ask before you receive care and look for the familiar Blue Cross Blue Shield symbol displayed in their offices. You can also check for a participating provider on your member website or by calling the Member Service number listed on the back of your ID card. Care you receive from non-participating providers

While it is to your financial advantage to use participating providers whenever possible, you are free to use non-participating providers who do not have agreements with Highmark Blue Cross Blue Shield. Non-participating providers are under no obligation to file claims for you or to accept the Blue Cross Blue Shield allowed amount as payment-in-full for their services. While many non-participating providers will agree to file your claims, some may not. You must then file a claim yourself. When you use non-participating providers, you may be responsible for paying not only your deductible and/or coinsurance, but also the difference between the amount your plan pays and the provider's actual charge for the service. You also may have to file claims or contact Highmark yourself prior to a hospital admission. Please NOTE: All inpatient hospital care (except maternity care) must be pre-certified to assure it is covered. A toll-free precertification phone number is included on the ID card you will receive after you enroll to make this precertification convenient. Some programs require members to pre-certify other services, so please refer to the specific coverage information you will receive after you enroll.

NOTE: Designation as Blue Distinction Centers® means these facilities’ overall experience and aggregate data met objective criteria established in collaboration with expert clinicians’ and leading professional organizations’ recommendations. Individual outcomes may vary. To find out which services are covered under your policy at any facilities, please contact your local Blue Cross and/or Blue Shield Plan; and call your provider before making an appointment, to verify the most current information on its Network participation and Blue distinction status. Neither Blue Cross and Blue Shield Association nor any of its Licensees are responsible for any damages, losses, or non-covered charges that may result from using Blue Distinction or other provider finder information or receiving care from a Blue Distinction or other provider. To find out more, contact your local Blue Plan. 

BLUE DISTINCTION®: THE SIGN OF QUALITY SPECIALTY CARE If you’re facing a serious medical procedure or surgery, look for the Blue Distinction designation of quality. The Blue Cross and Blue Shield Association awards the Blue Distinction designation to hospitals that deliver superior outcomes for high-risk, high-cost procedures, such as cardiac care, complex/rare cancers, knee/hip replacements, spine surgery and transplants. Blue Distinction Centers are available nationwide, so you can find quality care wherever you live, work or travel. To find a Blue Distinction Center, use the online address or Member Service number found on the back of your Member ID card, or go to www.bcbs.com/bluedistinction/bdcfinder.

YOU GET A RANGE OF COVERED CARE Classic Blue Comprehensive provides integrated health care coverage. You’re covered for everything from sick care to inpatient and outpatient hospital care under a single plan. Following are some of your coverage highlights: Preventive Care Getting your preventive care can help you live a healthy lifestyle and avoid more serious and costly illness later. You are covered for certain preventive care benefits when received from a participating provider. Refer to your Summary of Benefits for the specifics on your coverage. Emergency Care More than anything, you want the reassurance of knowing that you’re covered when you need care most. Classic Blue Comprehensive covers all reasonably necessary costs associated with emergency care and services provided during the period of emergency. In a true emergency situation where you believe you need immediate treatment, go directly to your nearest emergency room or urgent center, or call “911” or your local emergency number. Once the crisis has passed, it’s wise to contact your primary care provider to arrange for appropriate follow-up care. You should use emergency services only when appropriate. In certain situations, such as for a strained muscle or the flu, it may make sense to contact your doctor, go to a retail health clinic (typically found in pharmacies), or go to the nearest urgent care center. When You Receive Services Outside Western Pennsylvania As a Highmark Blue Cross Blue Shield member, when you live or travel outside western Pennsylvania, you still have the opportunity to use participating providers. Blue Cross and/or Blue Shield Plans across the country have negotiated agreements with hospitals, doctors and other health care facilities and professionals. In most cases, participating providers outside the western Pennsylvania area will file claims for you to the local Blue Cross and/or Blue Shield Plan. All you need to do is show your Highmark Blue Cross Blue Shield member identification card. As with use of non-participating providers within Pennsylvania, using non-participating providers outside of western Pennsylvania will make you responsible to file your own claim and pay not only your deductible and/or coinsurance, but also the difference between the provider’s actual charge and the Blue Cross Blue Shield allowed amount. PLEASE NOTE: Some services are not covered with this program. You may be financially responsible for total payment to the provider for any services not covered by your program. Please refer to the information that you will receive after you enroll for a detailed list of services covered and not covered under your program.

YOU GET SERVICE & SUPPORT WHENEVER YOU NEED IT Make the most of your health coverage and make strides toward real health improvement! Take advantage of the many tools and resources available to you.

MAKE INFORMED CARE DECISIONS AND LIVE A HEALTHY LIFESTYLE: GET THE INFORMATION YOU NEED ONLINE OR BY PHONE

WebMD® Begin by logging into www.highmarkbcbs.com. Enjoy a healthier lifestyle with resources powered by WebMD, a trusted name in online health and wellness.

Wellness Profile- Take a few minutes to take this comprehensive health assessment on your member website. This confidential questionnaire covers all aspects of your health, including nutrition, weight management, physical activity, stress, injury prevention, skin protection, immunizations, and health measures such as blood pressure and cholesterol. Data from the Profile is used to generate a personalized action plan that helps you to identify areas in need of health improvement and includes online health and wellness programs and activities.

Health and Wellness Programs- You have a wide selection of online programs to

help you lead a healthy lifestyle: Check out all your available programs to help you eat healthy, get active, manage stress, lose weight, and quit smoking. And if you have a chronic health condition, such as asthma and diabetes, there are programs to help you better manage all aspects of your condition.

Health Education Tools- You have thousands of online educational resources! You

can look up full-color articles on health conditions, surgeries, procedures, medications and more. You can review care treatment options, check out a comprehensive health library and connect to recent health news articles.

Compare Costs and Save- The Care Cost Estimator lets you compare prices and quality from different health care providers. You can research 359 procedures, including inpatient,

outpatient, surgical, laboratory and diagnostics. Do side-by-side comparisons for quality ratings, convenience and cost-effectiveness. The cost estimates include all services related to a procedure-like physician fees, supplies and medications. It uses your own specific coverage to calculate what your out-of-pocket costs will be. Your own deductible, coinsurance and copay amounts are taken into account. Other online health tools help you make informed health care decisions. With reliable cost and quality information, they are easy to find and simple to understand.

Personal Health Record pulls together your history of health conditions, office visits, procedures, tests, medications and immunizations in one location

Compare Prescription Costs shows you how to save money by using generics

The Provider Directory helps you select health care professionals based on their

quality, experience, location and more.

Patient Experience Ratings let you see how other people rate doctors and medical facilities

Online Plan Activity Statement combines the claims information with spending account information into one, user-friendly document

Coming in 2014, an interactive, online experience that consolidates medical, dental, vision and pharmacy activity and spending account summaries. Everything is in one place on the member website, making it easy to track claims and medical spending.

Member Discounts – As a member, you’ll enjoy discounts on a wide range of health-related products and services, fitness club memberships, plus over-the-counter medications. You can save money on diet programs, and even wellness therapies. Just log on to your member website for all the details.

Not Yet Registered on your Member Website? If you are not yet registered on your member website, take a few minutes to establish your password and register online.

Want to “Go Mobile”? If you have a web-enabled phone you can access many of the same online features via phone. Use the same registration process and the same member ID and password. Just type www.highmarkbcbs.com in your mobile browser to be directed to the site.

If you are pregnant, you’ll want to join the free Baby Blueprints® Maternity Education and Support Program. Enrolling in Baby Blueprints gives you access to online information on all aspects of pregnancy and childbirth. And you’ll receive individualized support from a nurse Health Coach throughout your pregnancy and after your child is born. To enroll in Baby Blueprints, just call toll-free 1-866-918-5267.

Tell us more about you! As part of your health care coverage, you’re eligible for lots of “extras” to help you make the most of your benefits. Make sure you get all the information you need — in the way you prefer — by telling us about your preferences and other important member and family information. Go to www.highmarkbcbs.com to tell us which phone number is best for us to call, and give us your preferences for other communications. If you need special help, because English is not your native language or you belong to a racial, ethnic or cultural group that has not always received the appropriate quality of care, let us know. The race, ethnicity and language information you provide won’t affect your benefits or coverage, how much you pay or how we pay your claims. We are committed to protecting your personal information and handling it with respect and integrity. Providing this information is voluntary, but we encourage you to consider helping us help you to take charge of your health.

LANGUAGE ASSISTANCE SERVICES AVAILABLE FOR MULTIPLE LANGUAGES

ENGLISH If you need benefit information in a language other than English or someone to interpret, we’re here to help! If you are a member, call the number on the back of your identification card. The language assistance services are free. A printed copy is available for request. FRENCH Si vous avez besoin d’informations concernant les prestations dans une langue autre que l'anglais ou si vous souhaitez faire appel à un interprète, nous sommes là pour vous aider ! Si vous êtes membre, veuillez composer le numéro de téléphone qui figure au dos de votre carte d’identification. Les services d'aide linguistique sont gratuits. Une copie imprimée est disponible sur demande.

ARABIC إذا كنت بحاجة إلى معلومات عن منافعك بلغة غير اإلنجليزية أو كنت بحاجة إلى شخص يقوم بالترجمة، نحن ھنا للمساعدة!

توجد نسخة مطبوعة تقدم خدمات المساعدة اللغوية مجانا. اتصل بالرقم الموجود على ظھر بطاقة ھويتك.إذا كنت عضوا، .متاحة عند الطلب

GERMAN Wenn Sie Informationen über die Versicherungsleistungen in anderen Sprachen als Englisch wünschen oder einen Dolmetscher benötigen, helfen wir Ihnen gerne weiter! Mitglieder rufen die auf der Rückseite der Ausweiskarte aufgeführte Telefonnummer an. Die Übersetzungsdienste stehen kostenlos zur Verfügung. Eine gedruckte Ausfertigung ist auf Anfrage erhältlich. GREEK Εάν χρειάζεστε πληροφορίες για παροχές ασφάλισης σε μια άλλη γλώσσα εκτός από τα αγγλικά, ή χρειάζεσθε διερμηνέα, είμαστε εδώ να σας εξυπηρετήσουμε! Εάν είστε μέλος, καλέστε τον αριθμό που βρίσκεται στο πίσω μέρος της κάρτας συνδρομής σας. Οι υπηρεσίες γλωσσικής υποστήριξης είναι δωρεάν. Διατίθενται σε έντυπη μορφή κατόπιν αιτήματος. GUJARATI જો તમને લાભો સબંિંધત માિહતી અંગે્રજી િસવાયની કોઈ ભાષામા ંજોઈતી હોય અથવા કોઈ યિક્ત તમને માિહતીનુ ંઅથર્ઘટન કરી આપે તેવુ ંઈ છતા હો, તો અમે મદદ પ થવા અહીં હાજર છીએ! જો તમે સ ય હો, તો તમારા ઓળખપત્રની (આઈ.ડી. કાડર્ની) પાછળ આપેલા નબંર પર ફોન કરો. ભાષા સહાયતા સેવાઓ મફત આપવામા ંઆવે છે. િવનતંી કરવાથી છાપેલી નકલ ઉપલ ધ છે.

HINDI यिद आपको लाभ के संबंध म जानकारी अगें्रजी के अलावा िकसी अ य भाषा म चािहए या समझाने के िलए कोई यिक्त चािहए, तो हम आपकी सेवा म उपि थत ह! यिद आप एक सद य ह तो अपने पहचान-पत्र के पीछे िदए गए नंबर पर फोन कर। भाषा सहायता सेवा िनःशु क दी जाती ह। अनुरोध करने पर छपी हुई प्रित उपल ध है। REAN 보험혜택에 관한 정보를 한국어로 받고 싶으시거나 설명이 필요하시면, 저희들이

도와드리겠습니다! 이미 가입하신 분은 보험 카드 뒷 면에 있는 번호로 전화하십시오.

통역 서비스는 무료입니다. 요청하신 분에게는 인쇄본을 보내드립니다. POLISH Jeżeli potrzebujesz informacji o świadczeniach w języku innym niż angielski, lub potrzebujesz tłumacza, chętnie Ci pomożemy! Jeżeli jesteś członkiem, zadzwoń pod numer wskazany na odwrocie swojej karty identyfikacyjnej. Usługi dotyczące pomocy językowej są bezpłatne. Wersja papierowa dostępna jest na żądanie. PORTUGUESE Se necessita de informações sobre os benefícios noutro idioma, que não inglês, ou de um intérprete, estamos aqui para o ajudar! Se já é membro, telefone para o número no verso do seu cartão de identificação. Os serviços de assistência de idiomas são gratuitos. Está disponível uma cópia impressa a pedido. TAGALOG/FILIPINO Kung kailangan mo ng impormasyon sa benepisyo sa anumang wika maliban sa Ingles o kung kailangan mo ng tigasalin ng wika, narito kami para tumulong! Kung ikaw ay isang miyembro, tumawag sa numero sa likuran ng iyong card ng pagkikilanlan. Ang mga serbisyo sa tulong sa wika ay libre. Maaaring makakuha ng naka-print na kopya kapag hiniling. SPANISH Si necesita información en español sobre beneficios o alguien que le sirva de intérprete, estaremos para ayudarle. Si es un miembro, llame al número que se encuentra al reverso de su tarjeta de identificación. Los servicios de asistencia de idioma son gratuitos. Una copia impresa está disponible a petición. CHINESE MANDARIN 如果您需要索取中文福利信息或者需要有人为您翻译，我们可以帮助您！如果您是会员，请拨您的会员卡背面的电话号码。语言协助服务免费。如您需要福利小册,请跟我们索取

。

ITALIAN Se avete bisogno di informazioni in italiano o di qualcuno che vi faccia da interprete, siamo qui per aiutarvi! Se siete soci, chiamate il numero sul retro della vostra tessera identificativa. I servizi di assistenza linguistica sono gratuiti. Una copia stampata è disponibile su richiesta. RUSSIAN Если Вам необходима информация на русском языке о льготах или нужна помощь переводчика, то мы Вам поможем! Если Вы уже являетесь участником нашей программы, позвоните по номеру телефона, приведенному на обороте Вашей идентификационной карточки участника. Услуги языковой помощи бесплатны. Письменный экземпляр предоставляется по запросу. VIETNAMESE Nếu quý vị cần thông tin về quyền lợi bằng tiếng Việt hoặc cần một người thông dịch, chúng tôi có mặt để giúp quý vị! Nếu quý vị là hội viên, hãy gọi số ghi ở phía sau trẻ ID của quý vị. Dịch vụ hỗ trợ ngôn ngữ là miễn phí. Có sẵn bản in nếu yêu cầu. THAI หากคุณตอ้งการรับประโยชน์จากขอ้มูลในภาษาอ่ืนนอกเหนือจากภาษาองักฤษหรือตอ้งการผูท่ี้จะตีความให ้เราอยูท่ี่น่ีแลว้เพ่ือช่วยคุณ! หากคุณเป็นสมาชิก โปรดโทรศพัทไ์ปตามเลขหมายท่ีอยูด่า้นหลงัของบตัรประจาํตวัของคุณ บริการช่วยเหลือดา้นภาษาน้ีเป็นบริการฟรี สาํเนาฉบบัพิมพอ์อกใหไ้ดเ้ม่ือร้องขอ JAPANESE あなたが英語以外の言語で記載されている給付情報が必要な場合、または誰かに通訳を

してもらう必要がある場合、私たちがお手伝いできます！あなたがメンバーである場合

、あなたのIDカードの裏に記載されている番号までお電話をかけてください。言語支援

サービスは無料です。印刷されたコピーは、要求に応じて提供されています。

URDU اگر آپ کو بییفٹ (وظیفہ) سے متعلق معلومات انگریزی کے عالوه کسی دوسری زبان میں درکار ہے یا اسے

ہیں تو، اپنے شناختی سمجھنے کے لیے کسی شخص کی ضرورت ہے تو، ہم مدد کے لیے موجود ہیں! اگر آپ ممبر ہیں۔ درخواست کرنے پر ایک چھپی کارڈ کی پشت پر درج نمبر پر کال کریں۔ زبان سے متعلق مدد کی خدمات مفت

ہوئی کاپی دستیاب ہے۔

ADDITIONAL IMPORTANT INFORMATION DETERMINING YOUR CARE COVERAGE For benefits to be paid under your program, services and supplies must be considered “Medically Necessary and Appropriate.” Medical Management & Policy (MM&P) is responsible for determining that care is medically necessary and provided in the appropriate setting. MM&P will review your care to assure it is “medically necessary and appropriate,” that is:

in accordance with generally accepted standards of medical practice;

clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patient’s illness, injury or disease; and

not primarily for the convenience of the patient, physician, or other health care

provider, and not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury or disease.

HOW WE PROTECT YOUR RIGHT TO CONFIDENTIALITY We have established policies and procedures to protect the privacy of our members’ protected health information from unauthorized or improper use. As permitted by law, we may use or disclose protected health information for treatment, payment and health care operations, such as: claims management, routine audits, coordination of care, quality assessment and measurement, case management, utilization review, performance measurement, customer service, credentialing, medical review and underwriting. With the use of measurement data, we are able to manage members’ health care needs, even targeting certain individuals for quality improvement programs, such as health, wellness and disease management programs. If we ever use your protected health information for non-routine uses, we will ask you to give us your permission by signing a special authorization form, except with regard to court orders and subpoenas. You have the right to access the information your doctor has been keeping in your medical records and any such request should be directed first to your network physician.

You benefit from the many safeguards we have in place to protect the use of data we maintain. This includes requiring our employees to sign statements in which they agree to protect your confidentiality, using computer passwords to limit access to your protected health information, and including confidentiality language in our contracts with doctors, hospitals, vendors and other health care providers. We provide aggregate information to employer groups whenever possible. In those instances where protected health information is required, the employer group will be required to sign an agreement before the information is released. Our Privacy Department reviews and approves policies regarding the handling of confidential information. Recognizing that you have a right to privacy in all settings, we even inspect the privacy of examination rooms when we conduct on-site visits to doctors’ offices. It’s all part of assuring that your protected health information is kept confidential.

MEMBER RIGHTS & RESPONSIBILITIES You have the right to:

1. Receive information about Highmark Blue Cross Blue Shield, its products and services, and members’ rights and responsibilities.

2. Be treated with respect and recognition of your dignity and right to privacy. 3. Participate with practitioners in decision making regarding your health care. This

includes the right to be informed of your diagnosis and treatment plan in terms that you understand and participate in decisions about your care.

4. Have a candid discussion of appropriate and/or medically necessary treatment options for your condition(s), regardless of cost or benefit coverage.

5. Voice a complaint or appeal about your Plan or the care provided, and receive a reply within a reasonable period of time.

6. Make recommendations regarding the Members’ Rights and Responsibilities policies. You have the responsibility to:

1. Supply to the extent possible, information that the organization needs in order to make care available to you, and that its practitioners and providers need in order to care for you.

2. Follow the plans and instructions for care that you have agreed on with your practitioners.

3. Communicate openly with the physician you choose. Ask questions and make sure you understand the explanations and instructions you are given, and participate in developing mutually agreed upon treatment goals. Develop a relationship with your doctor based on trust and cooperation.

You Asked. We Listened. Our mobile website offers the features that you want most in order to help you better manage your health.

Find doctors, hospitals, imaging centers, etc., based on your current location and health plan

View Member ID cards Review your claims Access health and wellness information Contact us And more…

The same ID and password for the full site can be used on the mobile site. To access, just type highmarkbcbs.com in your mobile browser.

CLASSIC BLUE COMPREHENSIVE OFFERS YOU:

Control over your care - you decide who provides you care Coverage for an exceptional range of preventive care Coverage for emergency care wherever and whenever you need it Responsive, toll-free member service Toll-free, 24 hour-a-day health care support Reliable coverage from a health care insurer in the business for more than 70 years --

Highmark Blue Cross Blue Shield

Highmark Blue Cross Blue Shield and Highmark Health Insurance Company are independent licensees of the Blue Cross and Blue Shield Association. Baby Blueprints, Blue Cross, Blue Shield and the Cross and Shield symbols are registered service marks of the Blue Cross and Blue Shield Association. Classic Blue is a service mark of the Blue Cross and Blue Shield Association. Highmark is a registered mark of Highmark Inc. 01/2014